Initial studies suggest that women living in U.S. territories may experience barriers to appropriate breast cancer diagnosis and treatment. Our purpose was to evaluate mammography screening engagement in U.S. territories compared with U.S. states. Women aged 50-74 years in the 2016 Behavioral Risk Factor Surveillance System survey without personal history of breast cancer were included. Proportions of women reporting mammography use were calculated. Multivariable logistic regression models were used to compare self-reported mammography use in U.S. territories with all U.S. states. Our total study population included 131,320 women. Of this group, 2,481 were from U.S. territories. In our adjusted analyses, women in the U.S. Virgin Islands were less likely to report mammography use (OR 0.52) compared with women in the U.S. states. Women in other U.S. territories reported mammography at similar rates to U.S. states. Targeted interventions accounting for unique, territory-specific barriers are likely required to improve screening engagement.